O2091: Identifying Brace Compliance Trends in Adolescent Idiopathic Scoliosis

Background: Scoliosis is a 3D deformity of the spine that is reported in about 3% of children younger than the age of 16. Full-time brace wear, characterized as 18 hours/day, is prescribed if the curvature is greater than 20 - 40 degrees. Although adherence to bracing leads to a 72% success rate at preventing surgery, compliance is variable and children sometimes only achieve 10% of the recommended time. We sought to identify a subset of patients that struggle with brace wear and describe statistical patterns associated with brace wear compliance. These trends will be analyzed and used to develop new measures that will target better brace wear adherence.

Methods: We conducted a retrospective cohort study of 62 patients between the ages of 6 and 17 being treated for idiopathic scoliosis at Stanford children’s Health. PROMIS surveys were used as a patient reported outcome tool to assess an individual’s physical, emotional, and social quality of life. A mixed-effects logistic regression model was used to estimate the effects of gender, age, time from brace prescription, weekends, and seasons on a patient’s odds of achieving their 18 hours of prescribed brace wear per day, as measured by thermochron compliance monitors. An analysis of variance (ANOVA) test and Fisher’s exact test were used to analyze demographic differences between patient compliance pattern groups.

Results: With respect to brace wear patterns among the 62 patients, 26 (42%) displayed a progressive decrease in hours worn daily, 17 (27%) remained consistent (mean < 18 hours), 7 (11%) increased, and 12 (19%) remained consistent (mean >18 hours) over the duration of time studied. Analyzing age as a compliance factor revealed that older age was associated with decreasing brace wear patterns and younger age with increasing patterns. Increasing agewas associated with decreased odds of compliance. Odds ratio (OR) = 0.60 (95% CI 0.40 - 0.90). Increase in months since brace prescription was associated with decreased odds of compliance OR= 0.92 (95% CI 0.92 - 0.93), while weekends were associated with decreased odds of compliance OR=0.84(95% CI 0.77-0.92). Relative to Summer months, fall, spring, and winter had increased odds of compliance, OR= 1.22 (95% CI 1.09-1.36), 1.21 (95% CI 1.07-1.35), and 1.37 (95% CI 1.22-1.54) respectively. The odds ratio for male vs female outcomes were statistically insignificant.

Conclusion: Older age, longer time since brace prescription, and weekends are compliance risk factors with a lower likelihood of achieving 18 hours of brace wear. Fall, spring, and winter months had a higher likelihood of achieving 18 hours of brace wear than summer months. We are currently exploring the effect of patient-reported MOBI surveys. Further areas of study will be needed to understand the association of these trends for other patient cohorts.